Resistant Arterial Hypertension Research Articles

Secondary hypertension due to a juxtaglomerular cell tumor

Juxtaglomerular cell tumors are rare, generally benign, and they are one of the secondary surgically treatable causes of arterial hypertension. There are about 100 reported cases on literature, and the diagnosis is usually carried out based on a high clinic suspicion index, mostly in patients with hypokalemia and arterial hypertension. The diagnosis involves blood tests and imaging studies, but it is only definite with histopathological exam after surgical treatment. We present a case of a 22-year-old woman with resistant arterial hypertension and renal and cardiovascular target-organ lesions. High plasmatic renin and a nodular renal mass on magnetic resonance imaging were present. A tumorectomy was performed and the histological exam confirmed a reninoma. After surgery, blood pressure and serum renin values returned to normal without medication. This work focuses on the need to exclude rare secondary causes of hypertension in young patients with resistant forms of this disease.

DOES HYPERURICEMIA INFLUENCE ON EFFICACY OF RADIOFREQUENCY SYMPATHETIC DENERVATION OF THE RENAL ARTERY?

Objective: Hyperuricemia is a risk factor for chronic renal insufficiency and is frequently encountered in patients with arterial hypertension (AH). However the impact of hyperuricemia on efficacy of radiofrequency sympathetic denervation (RFD) of the renal artery in patients with resistant AH (RAH) has not been fully appreciated. The objective of the study was to assess the efficacy of RFD of the renal artery in patients with RAH and hyperuricemia one year after the procedure. Design and method: 15 patients with RAH and hyperuricemia were examined while a comparison group consisted of 12 patients with RAH and without hyperuricemia. All patients received five antihypertensive drugs including diuretics. At baseline and one year after RFD of the renal artery the following parameters were assessed: 24-hour blood pressure monitoring, glomerular filtration rate (GFR) based on Modification of Diet in Renal Disease (MDRD) equation, 24-hour microalbuminuria and left-ventricular myocardial mass index (LVMMI). Results: In one year after RFD of the renal artery the significant decrease in mean 24-hour systolic and diastolic BP was detected in both groups according to 24-hour blood pressure monitoring. GFR level significantly decreased in main group of patients. No changes in microalbuminuria were found. LVMMI did not reach significant differences in patients with RAH and hyperuricemia while significant decrease was observed in a comparison group. Conclusions: In patients with RAH and hyperuricemia one year after RFD of the renal artery along with identical hypotensive effect the significant reduction in GFR was observed. Moreover, no decrease in LVMMI was detected that might be caused by a latent kidney disease providing additional factors for maintenance of AH.

THE ROLE OF HIGH DIETARY SALT INTAKE IN DEVELOPMENT OF RESISTANT HYPERTENSION

Objective: Aim of the study: evaluate salt-taste sensitivity and daily salt intake in patients with resistant arterial hypertension (RAH) during antihypertensive treatment (AHT). Design and method: The study included 137 patients with high risk arterial hypertension in average age 56.6 ± 9.8 years. All patients took triple combination AHT with diuretic, RAAS-blocker and calcium antagonists during 3 months. After 3 months therapy 83.2% patients were achieved goal BP, 16.8% of them were resistant to triple combination AHT. Thus, patients divided into 2 groups: RAH (n = 23) and non-RAH (n = 114) and continued AHT with recommendation to reduce dietary salt intake to 5–6 g/24 h. Salt-taste sensitivity (STS) evaluation, implemented R.Henkin method with using sodium chloride in different concentration: from 0.01% to 1.28%. The patients divided to 3 STS thresholds: low (0.01%-0.08% NaCl), medium (0.16% NaCl), and high thresholds (>0.32% NaCl). Daily salt intake was calculated by urinary sodium excretion level multiply 2.55, before and after treatment. Results: Patients with RAH characterized with significantly high systolic and diastolic BP (SBP/DBP): 178.1 ± 15.4/103.3 ± 10.1 mmHg vs. 158.9 ± 13.3/98.7 ± 7.25 mmHg in non-RAH group (p = 0.0001). STS test was shown prevalence high threshold of STS in RAH patients (high/medium 90.5%/9.5% χ2 = 46.7, p = 0.0001) in comparison with non-RAH group (high/medium/low 74%/12%/14% χ2 = 130.4, p = 0.0001) with significant difference in sodium chloride concentration: 0.41 ± 0.17% vs. 0.3 ± 0.18%, p = 0.01, for RAH and non-RAH groups respectively. Before AHT daily urinary sodium excretion rate was high in RAH patients (5.66 ± 2.49 g/24 h vs. 4.5 ± 2.54 g/24 h, p = 0.056), that corresponded to 14.4 g and 11.47 g daily salt intake in RAH and non-RAH respectively. During 6 months therapy BP significantly decreased in both groups, but in non-RAH group BP reducing was better with statistical difference: 128.3 ± 11.46/80.8 ± 7.9 mmHg vs. 122.4 ± 6.0/76.36 ± 8.5 mmHg, p = 0.0001 and p = 0.022 for SBP and DBP respectively. Daily urinary sodium excretion rate was significantly decreased only in non-RAH patients in comparison with RAH patients with statistical difference: 3.8 ± 2.29 g/24 h vs. 5.46 ± 2.7 g/24 h (p = 0.006). Conclusions: Patients with RAH characterized with high STS threshold and dietary salt intake. During six monthly optimal AHT, BP significantly reducing in both groups, but in non-RAH patients BP and daily urinary sodium excretion was statistically lower.

Stimulation of the baroreceptors for the treatment of resistant arterial hypertension. Clinical trials

Stimulation of the baroreceptors for the treatment of resistant arterial hypertension. Clinical trials

Resistant Hypertension On Treatment (ResHypOT): sequential nephron blockade compared to dual blockade of the renin-angiotensin-aldosterone system plus bisoprolol in the treatment of resistant arterial hypertension \u2013 study protocol for a randomized controlled trial

BackgroundResistant hypertension is characterized when the blood pressure (BP) remains above the recommended goal after taking three antihypertensive drugs with synergistic actions at their maximum recommended tolerated doses, preferably including a diuretic. Identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether acting on the control of intravascular volume or sodium balance, or acting on the effects of the renin-angiotensin-aldosterone system (RAAS) on the kidney.Methods/designThis is a randomized, open-label, clinical trial is designed to compare sequential nephron blockade and its contribution to the intravascular volume component with dual blockade of the RAAS plus bisoprolol and the importance of serum renin in maintaining BP levels. The trial has two arms: sequential nephron blockade versus dual blockade of the RAAS (with an angiotensin converting enzyme (ACE) inhibitor plus a beta-blocker) both added-on to a thiazide diuretic, a calcium-channel blocker and an angiotensin receptor-1 blocker (ARB). Sequential nephron blockade consists in a progressive increase in sodium depletion using a thiazide diuretic, an aldosterone-receptor blocker, furosemide and, finally, amiloride.On the other hand, the dual blockade of the RAAS consists of the progressive addition of an ACE inhibitor until the maximum dose and then the administration of a beta-blocker until the maximum dose. The primary outcomes will be reductions in the systolic BP, diastolic BP, mean BP and pulse pressure (PP) after 20 weeks of treatment. The secondary outcomes will evaluate treatment safety and tolerability, biochemical changes, evaluation of renal function and recognition of hypotension (ambulatory BP monitoring (ABPM)). The sample size was calculated assuming an alpha error of 5% to reject the null hypothesis with a statistical power of 80% giving a total of 40 individuals per group.DiscussionIn recent years, the cost of resistant hypertension (RH) treatment has increased. Thus, identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether by acting on the control of intravascular volume or sodium balance, or by acting on the effects of the RAAS on the kidney.Trial registrationSequential Nephron Blockade vs. Dual Blockade Renin-angiotensin System + Bisoprolol in Resistant Arterial Hypertension (ResHypOT). ClinicalTrials.gov, ID: NCT02832973. Registered on 14 July 2016. First received: 12 June 2016. Last updated: 18 July 2016.

CARDIOVASCULAR AND METABOLIC IMPAIRMENT IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Since the moment when the obstructive nature of sleep apnea was first revealed, many new in-formation on this disease have been obtained. Now obstructive sleep apnea (OSA) recognized as an independent predictor of the development of impaired glucose tolerance (insulin resistance, fasting hyperglycaemia), type 2 diabetes mellitus (DM2), resistant arterial hypertension, cardio- vascular death. The problem of identifying and treating patients with OSA is still actual. In real clinical practice, there is a need for an integrated approach to the diagnosis and therapy of comorbid OSA patients with metabolic impairment and cardiovascular diseases. The aim of this review is to assess the clinical and pathogenesis features of metabolic impaired, carbohydrate metabolism, basic metabolism, eating behavior, body weight fluctuations in patients with ob-structive sleep apnea syndrome. Methods. In our work, we used a retrospective analysis of pub-lished clinical research data of domestic and foreign authors over the past 20 years. The review included studies with adequate design from the standpoint of «good clinical practice» (GCP) and evidence-based medicine. The conclusion . According to modern interpretation, obstructive sleep apnea is considered as an independent disease that has its pathogenic mechanisms, clinical and functional manifestations. There are several main causes of the effect of OSA on the metabolic component and the work of the cardiovascular system. Among them, intermittent hypoxemia, endothelial dysfunction, fluctuations in intrathoracic pressure, increased activity of the sympathetic nervous system, disturbance of the structure of sleep are leading. OSA is considered as a disease capable of disabling patients of working age, dramatically changing the quality of life, leading to early mortality due to cardiovascular disasters. Timely detection of clinical symptoms of OSA and the strategy of early administration of CPAP therapy significantly improve the quality of treatment and prognosis of comorbid patients.

ОПРАЦЮВАННЯ РІЗНИХ МЕТОДИК ВИКЛАДАННЯ ДИФЕРЕНЦІЙНОЇ ДІАГНОСТИКИ ЕСЕНЦІАЛЬНОЇ РЕЗИСТЕНТНОЇ ТА ПСЕВДОРЕЗИСТЕНТНОЇ АРТЕРІАЛЬНОЇ ГІПЕРТЕНЗІЇ ДЛЯ ЛІКАРІВ-ІНТЕРНІВ ЗІ СПЕЦІАЛЬНОСТІ “ЗАГАЛЬНА ПРАКТИКА – СІМЕЙНА МЕДИЦИНА”

Мета роботи – оцінити ефективність засвоєння лікарями-інтернами удосконаленої нами методики диференційної діагностики есенціальної РАГ та ПРАГ у порівнянні з загальноприйнятою методикою.Основна частина. У дослідження було включено 120 пацієнтів (чоловіків – 68 (56,7 %); жінок – 52 (43,3 %); середній вік – (55±8,8) року) з гіпертонічною хворобою. Всі пацієнти мали вихідний рівень артеріального тиску (АТ) вище за 140/90 мм рт. ст. при прийомі 3-х та більше антигіпертензивних препаратів (АГП), один із яких діуретик. Лікарі-інтерни першого року навчання були розподілені на дві групи: І група – контрольна (30 інтернів) – опрацьовувала традиційну методику диференційної діаг­ностики есенціальної РАГ та ПРАГ; ІІ група (30 інтернів) – навчалась нової методики диференційної діагностики есенціальної РАГ та ПРАГ.Строки проведення диференційної діагностики РАГ та ПРАГ запропонованою нами методикою склали (3,9±2,6) дня, у порівнянні з традиційною методикою – (16,4±6,8) дня (p<0,01). Впровадження запропонованої методики дозволило лікарям-інтернам основної групи краще орієнтуватись у причинах вторинних форм РАГ – 25 ((83,3±6,8) %), у порівнянні з контрольною групою – 14 ((46,7±9,1) %) інтернів (p<0,01). Внаслідок проведеної роботи збільшилась кількість інтернів, які опанували методику диференційної діагностики РАГ та ПРАГ, з 12 ((40,0±8,9) %) до 24 ((80,0±7,3) %) в основній групі (p<0,001), та з 14 ((46,7±9,1) %) до 18 ((60,0±8,9) %) інтернів контрольної групи (p>0,5).Висновок. Удосконалена нами методика викладання знань і навичок диференційної діагностики есенціальної РАГ і ПРАГ дозволяє значно скоротити строки її проведення та достовірно покращити засвоєння знань і практичних навичок у лікарів-інтернів зі спеціальності “Загальна практика – сімейна медицина”.

Resistant hypertension: a therapeutic challenge.

Resistant hypertension: a therapeutic challenge.

Baroreflex Activation Therapy in Resistant Arterial Hypertension: Results from Updated Prospective Ambulatory Blood Pressure Follow-up Registry

Baroreflex Activation Therapy in Resistant Arterial Hypertension: Results from Updated Prospective Ambulatory Blood Pressure Follow-up Registry

Операция каротидной эндартерэктомии у больных с резистентной артериальной гипертензией

Операция каротидной эндартерэктомии у больных с резистентной артериальной гипертензией

Фармакотерапия резистентной артериальной гипертензии

Pharmacotherapy of resistant arterial hypertension represents a serious problem, because today there are no clear algorithms of action in this clinical situation. The review discusses the key works in which the authors propose a solution to this problem. The variants of a differentiated approach to treatment based on hemodynamic type, plasma renin activity, as well as a number of empirical strategies, including the predominant use of mineralocorticoid receptor antagonists, are discussed.

Транскатетерная симпатическая денервация почек в лечении резистентной артериальной гипертензии: современное состояние вопроса

Транскатетерная симпатическая денервация почек в лечении резистентной артериальной гипертензии: современное состояние вопроса

PP.05.29] CIRCADIAN RHYTHM OF BLOOD PRESSURE AND TARGET ORGAN DAMAGE IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: To investigate characteristics of circadian blood pressure rhythm, frequency and character of hypertensive damage of heart, kidney and carotid arteries in patients (pts.) with true resistant arterial hypertension (RAH). Design and method: 43 essential hypertensive pts. were included in the study. According to office and ambulatory BP measurement after 2 month of treatment with fixed dose combination perindopril/indapamide/amlodipine 10/2.5/10 they were divided into two groups: the 1-st - 22 pts. with confirmed RAH and the 2-d - 21 pts. with controlled arterial hypertension (AH). Before starting of treatment pts. were underwent ambulatory blood pressure monitoring (ABPM),, ultrasonography of heart and carotid arteries, laboratory tests (serum creatinine and 24-hour albuminuria). Results: Two groups were comparable in age (51.4 ± 2.6 vs. 54.2 ± 1.9 y, p = 0.63), body mass index (32.2 ± 0.9 vs. 33.4 ± 1.1 kg/m2, p = 0.35) and office systolic (174.4 ± 4.1 vs. 175.5 ± 4.5 mmHg, p = 0.78) and diastolic (97.3 ± 4.4 vs. 102.4 ± 2.4 mmHg) BP. But pts. with RAH had higher level of ambulatory systolic BP (SBP), than patients of comparing group: average diurnal SBP 169.2 ± 2.8 vs. 159.0 ± 2.8 mmHg (p = 0.03), average daytime SBP 173.5 ± 2.9 vs. 164.6 ± 2.4 mmHg (p = 0.04) and average nighttime SBP 161.9 ± 3.4 vs. 148.6 ± 4.2 mmHg (p = 0.02). Ambulatory diastolic BP doesn’t differ between two groups: average diurnal DBP 96.2 ± 3.3 vs. 89.5 ± 2.3 mmHg (p = 0.27), average daytime DBP 100.4 ± 3.5 vs. 94.0 ± 2.4 mmHg (p = 0.24) and average nighttime DBP 88.5 ± 3.2 vs. 80.6 ± 2.4 mmHg (p = 0.19). Diurnal systolic and diastolic BP index was significantly lower in RAH patients – 6.7 ± 1.2 vs. 10.1 ± 1.4% and 11.6 ± 1.1 vs. 15.0 ± 1.3% respectively. Disturbance of circadian BP rhythm was detected in72.7% RAH pts. in compare with43.0% pts. with controlled AH. LVH (concentric type in all cases) was diagnosed at 100% RAH pts. and in 90% pts. in comparing group (concentric type in 61.5% of cases). Frequency of carotid atherosclerosis (68.8 vs. 46.6%) and intima-media thickness (1.49 ± 0.07 vs. 1.17 ± 0.06 mm, p = 0.003) were significantly higher at RAH than at controlled AH pts. Glomerular filtration rate was equal in comparing groups when albuminuria was greater in RAH pts.-18.4 ± 3.3 vs. 15.2 ± 2.1 mg/l (p = 0.03). Conclusions: RAH pts. characterizes by higher level of ambulatory SBP and more frequent disturbances of BP circadian rhythm in comparing with controlled AH pts. These peculiarities of ambulatory BP is accompanied with concentric LVH, atherosclerotic and hypertensive damage of carotid arteries and signs of kidney injury.

LB.03.08] RENAL FUNCTIONAL DISTURBANCIES IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENTION IN COMBINATION WITH RENAL ARTERY ABNORMALITIES

Objective: The aim of this study was to assess clinical renal disturbances in patients with resistant arterial hypertension (AH) in combination with renal artery abnormalities (RAA) in 4 years follow-up study. Design and method: 15 patients (6 males, 9 females) aged 44.1 ± 2.0 years with resistant AH (history of AH 16.5 ± 2.1 years) and RAA were examined; ambulatory blood pressure (BP) monitoring (ABPM) mean average of diurnal BP for systolic blood pressure (SBP) and diastolic blood pressure (DBP) as 160.9 ± 3.8 mmHg and 102.8 ± 2.7 mmHg, respectively; BMI 27.9 ± 1.4 kg/m2. The group was compared to the group of patients (n = 28, 11 males and 17 females) with normal renal arteries; aged 45.4 ± 1.8 years, history of AH 14.9 ± 1.3 years; diurnal SBP 158.2 ± 3.6 mmHg and DBP 95.8 ± 2.6 mmHg; BMI 29.3 ± 1.2. BP remained uncontrolled high despite the prescription of 4 antihypertensive drugs. The cases of pseudo-resistant AH had been excluded. Renal function features was evaluated by the dynamic nephroscyntigraphy in all the patients and the level of microalbuminuria was estimated (immunochemical analysis) initially and in 4 years follow-up. Results: Initially the patients with RAA had the level of urine microalbumin 39.38 ± 15.2 mg and in 4 years – 54.74 ± 20.7 mg, respectively (p > 0.05). And in the comparison group the level of microalbuminuria was stated at first point as 51.15 ± 24.9 mg and 4 years later - as 65.45 ± 24.4 mg (p > 0.05). Initially dynamic nephroscyntigraphy analysis presented maximum agent evacuating time (T max) as 6.15 ± 0.8 min and 4 years later – 3.7 ± 0.5 min (p < 0.05). In the comparison group this level was 6.45 ± 0.4 min and 5.7 ± 0.6 min, respectively (p > 0.05). Conclusions: As at first point and as 4 years later the level of microalbuminuria in patients with RAA had no significance differences with the comparison group. Maximum nephroscyntigraphy agent evacuating time (T max) significantly decreased in the main group in the 4 years follow-up period, and in patients with normal renal arteries there were no such changes. The findings may reveal severe growth rate of hypertensive nephrosclerosis of functioning renal parenchyma in patients with resistant AH and RAA.

PP.25.28] RENALASE PLASMA CONCENTRATION BEFORE AND AFTER RADIOFREQUENCY RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: Renalase is a catecholamine-metabolizing enzyme produced by proximal tubular cells in kidney which is supposed to be involved in blood pressure regulation. The aim of the study was to evaluate plasma renalase concentration before and after radiofrequency renal denervation (RDN) in patients with resistant arterial hypertension. Design and method: 19 patients (10 men, median age 56 (48; 57) years; BMI 30.9 ± 4.4 kg/m2 and eGFR 89 ± 17.7 ml/min/1.73 m2) with resistant hypertension were enrolled in the study. In all patient plasma renalase concentration was measured before and 1, 3, 6 and 12 months after RDN by ELISA method (Cloud-Clone Corp, Houston, USA). Results: A significant decrease of both office systolic and diastolic blood pressure 6 months after RDN was found (192 ± 31 vs. 177 ± 28 mmHg, p = 0.03; 113 ± 23 vs. 99 ± 21 mmHg, p = 0.002, respectively). One and 3 months after RDN plasma renalase concentration decreased significantly (p < 0.05 vs. baseline), with a subsequent return to values comparable with baseline at 6 and 12 months after RDN (NS vs. baseline) (median plasma renalase concentration 22100 vs. 18550 vs. 17600 vs. 20750 vs. 20500 ng/ml, respectively; Friedman analysis of variance p = 0.054). Conclusions: 1. Renal denervation leads to the temporary decrease of plasma renalase concentration in patients with resistant hypertension. 2. Lower plasma renalase concentrations seems to reflect a counteract reaction to blood pressure decline after successful renal denervation.

P5852Cerebral blood flow and cognitive function in patients with resistant arterial hypertension: before and after sympathetic nervous denervation of renal arteries

P5852Cerebral blood flow and cognitive function in patients with resistant arterial hypertension: before and after sympathetic nervous denervation of renal arteries

Clinical efficacy of sympathetic denervation of renal arteries in patients with resistant arterial hypertension as part of annual prospective follow-up

Objective. To study the clinical efficacy of sympathetic denervation of the renal arteries (RDN RA) in patients with resistant arterial hypertension (AH). Materials and methods. The study included 34 patients with resistant AH aged 27 to 70 years. Criteria for inclusion in the research: a resistant course of AH with a level of arterial pressure (BP) &gt;160/100 mm Hg. Art. (With a diuretic) at optimal doses, the preserved renal function (glomerular filtration rate &gt;45 ml/min) and the absence of a secondary form of AH, written informed consent. Results. RDN PA contributed to statistically significant A decrease in both office and average daily SBP and DBP, a clinical hypotensive effect was observed in men and women, however, in the night hours there was a more significant decrease in SBP in women. Conclusions. A prospective one-year observation confirmed a long-term Efficiency RDN RA in the treatment of patients with refractory hypertension.

Could careful patient selection for renal denervation warrant a positive effect on arterial stiffness and left ventricular mass reduction?

After the sequence of Symplicity HTN trials, the impact of the procedure on lowering blood pressure (BP) and cardiovascular risk is still debatable. We present initial results of the multimodal pilot study that aimed at carefully selecting proper patients and investigating the effects of RASD on cardiac morphology and central haemodynamic parameters in 15 patients with resistant arterial hypertension prior and 6 months after RASD. The multimodal (applanation tonometry, echocardiography and cardiac magnetic resonance (CMR)) study findings have shown a significant BP decrease (190/112 ± 23/12 to 153/91 ± 18/11 mm Hg, P < 0.002), a decrease of the arterial markers (carotid-femoral pulse wave velocity decreased from 11.46 ± 2.92 m/s to 9.17 ± 2.28 m/s and the augmentation index decreased from 25.47 ± 10.55 to 21 ± 12.19, P < 0.006), a significant left ventricular mass index decrease by 10% both by echocardiography (140.83 ± 38.46 to 115.26 ± 25.37 g/m2, n = 14, P < 0.001) and CMR (108.32 ± 39.02 to 97.25 ± 30.06 g/m2, n = 15, P = 0.003). A significant decrease of CMR retrograde flow volume in the ascending aorta non-dependent on BP was also found. Our study is characterised by strict and extensive patient selection criteria for renal artery sympathetic denervation (RASD), which seem to warrant a positive effect of the procedure on BP, arterial stiffness and left ventricular mass 6 months after RASD, although it should be confirmed in larger controlled trials.

CLINICAL AND FUNCTIONAL CHARACTERISTICS OF RESISTANT ARTERIAL HYPERTENSION

Мета дослідження – вивчити клініко-функціональні особливості резистентної і псевдорезистентної артеріальної гіпертензії.Матеріали і методи. Було обстежено 420 хворих з есенціальною артеріальною гіпертензією 2 стадії у віці від 45 до 74 років з тривалістю захворювання понад 3 роки з ознаками резистентності до проведеної гіпотензивної терапії. Всі пацієнти були поділені на 2 групи: 1 група – з резистентною АГ і 2 група – з псевдорезистентною АГ. У всіх пацієнтів оцінювали дані анамнезу, скарги, тривалість захворювання АГ, наявність супутніх захворювань. Були проведені всі необхідні загальноклінічні та інструментальні обстеження відповідно до поставлених завдань дослідження: загальноклінічне дослідження, ЕКГ, ЕхоКГ.Результати. В ході дослідження у 26,2 % пацієнтів була діагностована справжня резистентна АГ, у 73,8 % – псевдорезистентна АГ. Тривалість псевдорезистентної АГ в середньому склала (8,2±1,2) років, а резистентної АГ – майже вдвічі більше – (14,7±2,1) років. У хворих з резистентною АГ, порівняно з хворими з псевдорезистентною АГ, було виявлено більше скарг, вищі значення систолічного артеріального тиску, частіше зустрічалися супутня патологія і порушення серцевого ритму і провідності.Висновки. У хворих з резистентною АГ відзначається більш тяжкий перебіг АГ, що створює умови для підвищення загального кардіоваскулярного ризику.

The analysis of adhesive-dysfunctional endothely at resistant arterial hypertension

Aim: To examine the antihypertensive activity of Telmisartan and Bisoprolol at resistant hypertension.To evaluate the features of resistant hypertension and endothelial vasomotor and adhesive dysfunction.Methods: The level of adhesion molecules s-ICAM-1, L-selectin and matrix metalloproteinase-9 was determined by ELISA with regard to vasoactive function of the brachial artery, which is determined through the flow-dependent vascular dilatation sample. Determination of Nitrogen oxide was conducted on data metabolites of total Nitrogen (NOx) by determination of Nitrite ion after colorimetric reaction with Griess reagent using SF-46 spectrometer (Russia).Results. The studies have shown that six-month treatment by Telmisartan and Bisoprolol in most patients (22 patients) was accompanied by target levels of blood pressure achievement, and was observed in 14 patients resistant to the treatment. The additional inclusion in complex treatment Aliskiren 150-300 mg per day was also accompanied by normalization of blood pressure.Conclusion.1. The function of endothelial adhesion and appearance of endothelial dysfunction occur prior to hypertension clinical and morphological signs.2. Induced hypertension increase of sICAM-1 and L-selectin and matrix metalloproteinase-9 is a marker of hypertension severity and the treatment efficiency.3. Telmisartan and Bisoprolol significantly reduce the adhesive endothelial dysfunction and contribute to the achievement of target blood pressure levels